GP prescribing crackdown after review finds 600 excess deaths a year

The health secretary has promised to make the NHS the 'safest healthcare system in the world' with a new scheme to trace GP prescribing errors and prevent 600 deaths in primary care a year.

The new national system will link GP prescribing with hospital admissions data for the first time and see if a wrong prescription 'was the likely cause of a patient being admitted to hospital'.

The move comes after a Department of Health and Social Care-commissioned study found nearly three-quarters of the 66m potentially clinical significant medication errors were in primary care.

But the chair of the RCGP said this scheme should not be used to 'admonish' GPs for making genuine mistakes and that the long-term solution was a 'properly funded NHS'.

Announcing the strategy, first floated last year, the DHSC said it would see 'new systems linking prescribing data in primary care to hospital admissions so the NHS can see if a prescription was the likely cause of a patient being admitted to hospital'.

The DHSC said this would 'initially focus on how different medicines may be contributing to people being admitted to hospital with gastro-intestinal bleeding'.

Under the new system, 'doctors will, for example, be able to trace whether a patient prescribed a non-steroidal anti-inflammatory drug on a regular basis ended up in hospital with a gastro-intestinal bleed because they were not given something to protect their digestive system', the DHSC said.

But whilst GPs would seemingly face stricter scrutiny, the DHSC said pharmacists would have 'new defences' for when they make 'accidental medical errors rather than being prosecuted for genuine mistakes as is the case currently', which the DHSC said would 'ensure the NHS learns from mistakes and builds a culture of openness and transparency'.

And health secretary Jeremy Hunt said: 'We are taking a number of steps today, but part of the change needs also to be cultural: moving from a blame culture to a learning culture so doctors and nurses are supported to be open about mistakes rather than cover them up for fear of losing their job.'

The announcement also included a target to 'accelerate' the rollout of electronic prescribing to more NHS hospitals this year, with the ambition to 'reduce errors by up to 50%'. It said currently only a third of trusts have a 'well-functioning' e-prescribing system.

The DHSC said the action comes in response to new research showing the 'shocking toll' of medication errors in the NHS.

The study, commissioned by the DHSC and carried out by researchers from the Universities of Sheffield, Manchester and York, estimated that there were 66 million potentially clinically significant medication errors in England annually, 71% of which were in primary care, where most drugs are prescribed.

They further estimated that primary care medication errors leading to hospital admissions caused 627 deaths and cost the NHS £83.7m a year. In total across the NHS they estimated medication errors caused 712 deaths a year, costing £98.5m.

RCGP chair Professor Helen Stokes-Lampard said: 'What is essential, is that highlighting that prescribing errors do occasionally happen is not used to admonish hardworking NHS staff - including GPs - for making genuine mistakes, but to address the root cause, and in general practice that is intense resource and workforce pressures, meaning that workloads and working hours are often unsafe for GPs and our teams.

'New measures to help reduce prescribing risk are certainly helpful, but the long-lasting solution to this is a properly funded NHS with enough staff to deliver safe patient care.'

Medical Protection Society senior medicolegal adviser Dr Pallavi Bradshaw said: 'The move to bring in new defences for pharmacists who make accidental medication errors, rather than prosecuting them for genuine mistakes, is a step in the right direction.

'But to bring about a real shift towards a culture of openness, learning and improvement from system wide mistakes, these defences would need to be extended to doctors and other healthcare professionals. There has never been a more important time to debate this issue, and we are pleased work is underway.'

BMA GP committee chair Dr Richard Vautrey said the 'vast majority of prescribing is carried out to a high standard', adding that 'linking data to reduce prescribing risks is already happening in some areas'.

'The NHS needs to learn from these instances, and we hope these plans will lead to improved systems in hospitals and community settings that reduce the possibility of errors as much as possible.'

But he said it comes as GP practices 'are facing increasing demand on their services, with patients presenting with increasingly complex health problems, so the Government needs to continue to work with us to establish a workforce strategy', which he said should include 'greater involvement of pharmacists working in, or linked to, practices and surgeries'.

MDU medicolegal adviser Dr Caroline Fryar said: 'The MDU, of course, welcomes any initiative to improve patient safety. Medication errors can have a huge impact. For many years we have shared information with our members about common risks in order to help GPs to continue to practise safely.

'This initiative is unlikely to have any impact on the cost of indemnity.'

Labour's shadow health minister Justin Madders said: 'If we want the NHS to be the safest in the world then there are fundamental issues that need to be addressed.

'Ministers have to be much clearer about what extra funding and capacity they’ll be providing so that NHS staff can to do their jobs to the best of their ability, without mistakes, and to really ensure our NHS is as safe for patients as it can possibly be.'

A 2012 GMC analysis of prescription items found roughly one in eight patients was affected by a prescribing or monitoring error and, although only one in 550 errors was found to be severe, prompted changes to GP training.

A more recent audit of 500 practices’ prescribing, published in the BMJ in 2015, found around one in 20 patients received a prescription that should have been avoided as it could worsen their condition or interact with another medication.

GP leaders said at the time that pharmacist-led medication reviews could help boost safety and take pressure off GPs.

Readers' comments (61)

Dear All,looks like someone needs to go back to logic school. 71% of drug errors are caused by GPs, but 91% of all prescriptions are issued by GPs. So in fact GPs are 20% safer than other prescribers. Set aside all the "estimated" and "could"s and theoretical interactions that never actually arise its clear GPs are not the ones to be focussing on.....RegardsPaul C

Dear All So let's run those numbers again. GPs responsible for 71% of the alleged errors but issue 91% of the scripts. So that means the remaining 29%of errors come from those that are responsible for 9% of scripts. Thats 3 times the error rate. Regards Paul C

Your simple subtraction, when you actually consider the figures, does a poor job of analysing the numbers. I suggest you take another look before concluding GPs are 20% safer than other prescribers which is rather meaningless.

I see very poor prescribing on a daily basis, much of which does not lead to hospital admissions but does represent laziness and an attitude of taking less than the required degree of responsibility for the privilege of being a prescriber of potentially harmful poisons to patients.Typical examples include neutropenic patients on methotrexate having their FBC result marked "satisfactory" and the continued supplying of methotrexate; people on ARBs/ACE inhibitors who have not had an eGFR for over a year; diabetics who are continuing to receive their insulins when they have not had a blood work-up and review for over a year; people on oral iron for years when a quick scan of their results show that their Hb and ferritin have been normal for a number of years; patients on thyroxine for thyroid cancer requiring a supressed TSH but their TSH is in the normal range and the result marked "Normal" ....I could go on.

This kind of shoddy approach makes more work for those who bother to read the notes properly and magnifies their stress levels and, sad as it is to say, makes it a hazardous endeavour to rely on ones colleagues to do their job adequately. Moreover, this is one of the factors which has secondary care sneering at primary care ineptitude. Is it really asking too much for GPs to read the notes and interpret results in light of a patients particular circumstances, and to check that they are placing their signature (be it by pen or electronically) on a script that is being correctly monitored? I conclude that this poor practise is widespread and goes undetected because the notes are rarely scrutinised as they need to be to perform quality work which is taken with the responsibility it requires.

Isn't Dr BG a victim of the 'learning culture" JH wants.To me this feels like a bit of a witch hunt, how long before one of our brethren are called before the GMC for one of the mistakes.There is no mention of workload especially excessive workload which we are subjected to, no maximum patient contacts or queries.I for one spent 10-11 hour yesterday without a break declining with potential pit falls.50+ face to face contacts,Over 100 results to rv and deal with,50+ letter to file deal with and action on docman,30+ phone calls'nd hour long anticoagulation clinical meeting where our anticoagulation team reviewed DNA for the anticoagulation clinic, to action and deal with.On top of this I signed countless 150+ scripts.Yesterday was that good at the end of ItI still have a pile of hospital letters to go through.What have "learned" in the past week or too?Primary care is doomed to collapses as our local hospitals,The work load is unsafe and unsustainable.We have no way of controlling it unless we leave voluntarily.The GMC and our supposed leaders dont not care.If you make a mistake in this system you will be the one strung from the nearest lamp post as was Dr BG.Lastly after yesterday I would no mind being strung up from the nearest lamppost at least that would be and end to this nightmarish hell.Ive learned I have done the wrong degree and would encourge no-one to come into medicine never mind General Practice.Best wishes everyone.

Why have a safe healthcare system when you can have a cheap one. If the powers that be really wanted a safe system they would address the workload pressures as these are the key factors in errors. Its time for us to limited our workload on the back of this study. Patients will have to wait longer as we all factor administration into our sessions.

The more He talks about a safe learning health care system the more if becomes unsafe, blame cultured and a medical profession with a siege mentality looking to get out the door asap.This man has the reverse midas touch.Everything he touches turns to brown smelly stuff.I pity him the man who destroyed the NHS.The antithesis to Nye Bevan.Loathed and hated,I pity him and the party he will consign to the wilderness to serve a penance.

Here's some ideas....GPs to stop prescribing specialist medication...dmards...psych drugs...anticoag...amiodarone....specialists to monitor their own diseases eg thyroid cancer....there that will make the system much safer....oh hang on hospitals are less safe....

Pharmacists are paid a fee for dispensing a drug which is a safety mechanism. Pharmacists in hospitals check medications. From experience, I found a lot of drug errors from nursing homes giving the wrong drug or wrong quantity as well as patients who do not follow instructions. Stop bashing GPs. We are already on our knees. If Hunt really want safer prescribing, do it like GPs aborad. 15-30min consultations every 3months and no specialist drugs like methotrexate etc. If the GP does not see the patient there is no prescribing, rather than the hundreds of scripts we sign daily. You get what you pay for at the end of the day Jezza. Are we going to report errors? Dr Barwa Gaba's case says unless you want to face manslaughter charges. The system is broken and we must not be supporting or trying to blame ourselves. It is the way it has been set up with it's inherent risks.

IDGAF sounds like someone towing political lines or someone that has just come out of medical school or perhaps not even a GP. The lack of experience and ideology shows in the comments. How many scripts do you signed I wonder. Have you in your duty of care andas you said being in a position of responsibility and privilege corrected all the errors? We are practising in a toxic far from ideal blame culture climate with massive workloads. Yes everything sould be perfect and we should aim for this but we need the funding, the time and the staff all of which is in short supply. You get what you pay for. Welcome to rationalised health care. Safest and best in the world? In your dreams Jezza unless you fulfill the funding, staffing, time, training and equipment which as the slowest growing big economy now it will be impossible.